Current causes of sudden death in large populations: differences between resuscitated patients and autopsied cases

Aetiologies of sudden death (SD) have been reported in autopsied case series and less frequently in resuscitated patients, but large series are scarce and if causes are similar between deceased and surviving patients is unknown.

All successive adult patients with resuscitated SD (n = 283) and autopsied SD cases (n = 1258) over the last 10 years at our centre were included. Causes were detailed and compared between resuscitated and autopsied cases. Coronary artery disease was present in 87% of resuscitated patients and in 48% of autopsied subjects (P < 0.0001). In coronary artery disease patients, an acute coronary event was present in 85% of resuscitated patients vs. 22% of autopsied cases (P < 0.0001).

No coronary artery disease was present in 13% of resuscitated patients (42% cardiomyopathy, 58% primary electrical disease) and noncardiac causes were absent. In autopsied cases, some cardiomyopathy was present in 19%, noncardiac causes were noted in 16% (pulmonary embolisms, aortic dissections/aortic aneurysm ruptures or strokes, and brain/meningeal haemorrhages) and no apparent cardiac or noncardiac cause for explaining SD was present in 15% (sudden arrhythmic death syndrome).

In this large series of resuscitated and autopsied SD cases, coronary artery disease remains the main aetiology but was significantly less frequent in autopsied cases, with a majority of acute coronary events in resuscitated patients vs. a majority of remote myocardial infarction without fresh thrombus in autopsied cases. Noncardiac causes were present in 15% of autopsies but never in surviving patients.